A guide to pain relief during childbirth

Giving birth is a natural process for the body, but it does involve pain and discomfort. There are a number of ways pain can be reduced and relieved, through both medical and non-medical means. Your own experience of childbirth will be unique, and your choices of pain relief can be specifically tailored to your needs in consultation with your doctor.

A thorough knowledge of your options for managing and relieving pain can be empowering when approaching birth. It is a good idea to read about all your options, even those that don’t interest you now, and approach the experience with flexibility.

There are things you can do to reduce your pain level during birth even before labour begins.

Preparation for labour

Proper preparation for labour can make a huge difference to your experience of child birth. It allows you to prepare your body and mind as well as understand and plan your methods for coping with pain.

Some ways to prepare for labour include:

Antenatal classes

Antenatal classes and childbirth classes help you to understand the process of birth, to develop reasonable expectations and provide an opportunity for you to learn about different approaches to coping with pain during birth.

One approach to child birth focuses on the fact that the process is natural and healthy, and encourages mothers to accept pain as part of this and to focus on managing it rather than trying to avoid it completely. It focuses on natural, non-medical pain management techniques.

A related approach, the ‘coached birth’, emphasises the importance of active involvement of a birth partner in the birth process. This is often used as a way to avoid the use of pain relief medication until or unless absolutely necessary.

Antenatal classes will help you to find the best approach for you, and to understand how medical and non-medical pain relief can work together to give you the best birth experience possible.

Exercise

Regular exercise during pregnancy will help prepare your body for labour by increasing your general fitness and strengthening your muscles. The more fit and strong you are, the better your ability will be to tolerate labour. If you are experiencing pain or discomfort during exercise, discuss this with your doctor.

Diet

Eating a healthy diet during pregnancy is crucial for the development of your baby, but is also helpful in ensuring your body is ready for labour. A good diet will also assist you in maintaining a healthy weight, which helps prevent complications during labour.

Emotional support

Support from your partner or a friend, family member or birth partner can help you prepare for labour. Include them as you learn about the process and prepare for the delivery so they can help guide you through it.

Quit smoking

You can improve your general health and the health of your baby by quitting smoking. This will also improve your breathing, reduce the risk of complications during childbirth, and promote healing after the birth.

Positive outlook

Mindset matters, so understanding that labour is a normal and healthy part of pregnancy and approaching it with a positive attitude will give you a good foundation for the birth. An understanding of the way your body works during the different stages of labour and of your options for pain relief can be very empowering.

 

Pain during different stages of labour

In late pregnancy, your body begins to ready itself for giving birth, leading to a number of pre labour symptoms. Hormones instruct ligaments in the pelvis to relax and loosen over these final weeks, and the uterus tightens. You may experience pre labour pains and discomfort in your abdomen and lower back during this time.

When labour begins, this pain from tightening and loosening transitions into regular contractions that feel like a stronger version of period pain and last more than thirty seconds each. These early labour pains will become more intense and closer together as the first stage of labour progresses.

During the first stage of labour, your cervix softens, thins out, and then slowly opens (dilates). Once the cervix is fully dilated, you transition into the second stage of labour and the baby moves down the birth canal until, through a combination of contractions and pushing, the baby is born. The third stage of labour takes place after the baby is born, as you deliver the placenta and membranes.

The different stages of labour bring different types of pain at different levels of intensity. Pain may be caused by several different things, including contractions of the uterus, the stretching of tissues in the birth canal, and pressure on different parts of the body as the baby is born. Women usually experience pain in the abdomen, groin and back during birth.

It is impossible to predict the precise level of pain you will experience during labour. There are a number of different factors that will contribute to the intensity and types of pain, including:

  • The size of the baby
  • The size of your pelvis
  • The position of the baby in the birth canal
  • Any medications or procedures used
  • The effectiveness of your contractions
  • The length of your labour
  • Fatigue
  • Fear or anxiety
  • Your preparation level
  • Any coping methods used
  • Your past experiences of pain and/or birth

Many women find they are physically and mentally more prepared for birth the second time. Some report that their second or subsequent birth experience is less painful for them than their first, but this is not always the case.

 

Types of pain relief during labour

 

Non-medical

Non-medical methods of pain relief can be very effective at managing pain. Natural pain relief may be used during the entire labour (especially when labour is progressing well and without complications) or just during early labour before medical pain relief is necessary. Many of these pain relief options involve techniques that need to be learned and practiced during pregnancy, so start thinking about what options appeal to you as early as possible.

Relaxation techniques

There are a number of relaxation techniques marketed for use during labour. Audio recordings or music are often used to help guide you. These techniques should be learned early in pregnancy and practiced often before birth.

Breathing exercises

Breathing techniques are often taught during antenatal classes as a way to manage pain. They can also be useful if using gas as a form of pain relief during labour, as this relies on controlled breathing for delivery.

Massage and touch

Your birth partner may massage you or rub your back during or between contractions to provide some relief, especially during early labour.

Yoga

Some yoga positions can provide relief from pain and may assist in the birthing process. This should be practiced during pregnancy to ensure you are able to properly perform the positions.

Hypnosis

Hypnosis (either with a partner, or through self-hypnosis) can be useful in managing pain. This needs to be practiced well in advance of giving birth to be used effectively.

Meditation

Meditation techniques can provide relief from pain and may also help control your breathing. If you wish to use meditation during your birth, you should learn and practice throughout your pregnancy.

Acupuncture

Acupuncture, administered by a medical practitioner who is experienced in using it, can be useful early in labour to relieve pain. This should be discussed with your doctor or other obstetric carer before the birth.  Acupressure may also be of assistance.

Heat

Heat can be very effective at relieving pain, and is usually delivered in the form of heat packs or a warm bath or shower. Warm water may also help you relax which will also contribute to pain relief.

Movement

Continuing to move around during labour can relieve pain and help labour progress. Switching positions, pacing, walking, and squatting can all be helpful, especially between contractions or earlier in labour.

If you have any questions or concerns about any of these options, consult your doctor, midwife or obstetrician.

You should read the information on medical pain relief even if you don’t plan to use it. It is difficult to predict how labour will progress, how much pain you will experience and how intense it will be, and whether there will be any complications that require pain relief. It is best to approach labour with flexibility. There is no failure in changing your mind or making use of all your options for the best possible outcome for both you and your baby. Even if you plan to say no, it is useful to have full knowledge of what you are turning down.

 

Medical

Medical pain relief can provide more complete alleviation of pain which may be necessary during intense pain or if natural pain relief methods are insufficient. Medical pain relief during childbirth is usually inhaled or injected, as painkillers given by mouth may not be absorbed properly during labour and can upset the stomach, leading to nausea and vomiting.

Nitrous oxide (pain relief gas)

A mixture of nitrous oxide and oxygen can be inhaled to relieve pain rapidly, usually in under a minute. Nitrous oxide is also known as gas and air, as well as laughing gas or happy gas. This gas is delivered through a facemask or mouthpiece, and is usually inhaled at the very beginning of each contraction so that adequate pain relief is in your system during the worst of the pain. Nitrous oxide can be inhaled throughout the entire labour and delivery, but it is not strong enough for some women. It will assist you in managing your pain, but it will not completely alleviate it. Some women do not find satisfactory relief using nitrous oxide as their only form of pain relief.

When using nitrous oxide, you may experience lightheadedness along with tingling in the hands, feet and lips. This is caused by an increase in your breathing rate, and can be managed with controlled breathing learned through breathing exercises that can be practiced during pregnancy. Some women find that nitrous oxide gas pain relief causes nausea, tiredness and a dry mouth. Sipping cold water or sucking on ice chips can help you feel better, but if you feel too unwell you can simply stop inhaling the gas and try a different form of pain relief.

Opioid injections

Pain-relieving drugs called opioids can be given by injection, usually into the thigh muscle or the buttocks, but sometimes into a vein. The most common drugs for this purpose are morphine and pethidine. Opioid injections do not completely get rid of pain, but they are usually very effective.

Opioids do not slow labour down or affect contractions, but they can cause side effects including nausea, vomiting and drowsiness. This pain relief method may also slow the baby’s breathing after birth, but this is easy to treat.

Opioid pain relief normally lasts about two hours, but this depends on your dose, the specific medication, and other factors. You can receive multiple doses over the course of the labour.

Anaesthesia

Anaesthesia is the most effective form of pain relief, and is usually able to block pain completely. These procedures require an anaesthetist to oversee them, which also means there may be delays in accessing this type of pain relief if the anaesthetist is busy with other patients or in surgery. Once delivered, however, anaesthesia is very effective and acts rapidly.

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Local anaesthesia

Local anaesthesia can be injected into the perineum or genitals just before birth in order to prepare for an episiotomy, or just after birth in order to numb the area for stitches to repair any tears. Local anaesthetic numbs the immediate area, but does not prevent pain elsewhere in the body, such as from labour contractions.

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Regional anaesthesia

Regional anaesthesia numbs part of the body but not all of it. During birth, this usually means numbing the lower half of the body with strong pain relief medication while allowing you to remain conscious, breathing on your own, and actively engaged in the labour.

There are three main types or regional anaesthesia:

  • Epidural anaesthesia
  • Spinal anaesthesia
  • Combination of spinal and epidural anaesthesia (CSE)

Epidural anaesthesia works by injecting pain-blocking medication into the epidural space around the spine. A small area of the lower back is numbed with local anaesthetic, then a needle is used to insert a thin tube (catheter) between two vertebrae (bones of the spine). The needle is removed and the catheter is left in place for the rest of the labour, allowing anaesthetic to be injected as required. The injection given may include an opioid in addition to the anaesthetic. An epidural during labour usually provides relief from pain within 10-30 minutes.

Spinal anaesthesia works by injecting pain-blocking medication into the fluid around the spinal nerve roots below the spinal cord. Again, a small area of the lower back is numbed with a local anaesthetic pain killer. Anaesthetic is then injected more deeply into the nerves, causing the body to become numb from the waist down. This kind of anaesthetic is delivered once only, works rapidly, blocks pain, and can last for hours. It is used for Caesarean delivery and may be used for forceps or vacuum-assisted deliveries.

In some circumstances, a combination of spinal anaesthesia and epidural anaesthesia (CSE) may be used in order to deliver pain relief rapidly while still allowing the anaesthetic to be topped up as required.

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General anaesthesia

General anaesthesia is only given during birth when there are complications and the benefits outweigh the risks involved. General anaesthesia has a higher rate of side effects and complications for both mother and baby, however is generally considered safe. The wellbeing of the mother and baby are always the highest consideration for doctors.

 

After delivery

You may continue to experience some pain after your baby is born. Most women experience pain in their abdomen, perineum, groin and back. This is more common if you had a Caesarean birth or had an episiotomy or tear. Some ways to reduce this pain are listed, both medical and non-medical.

 

Non-medical

Comfortable positioning

Many women find relief when lying on their side with a pillow between their knees, but you may find other positions also relieve pressure in tender areas.

Use of a pillow or cushion

You may choose to use a special donut-shaped pillow or cushion to make it more comfortable to sit in the days after you have given birth.

Salt baths

Salt baths can provide pain relief and promote healing of wounds. A sitz bath is a small salt bath just for your genitals, and can provide more topical relief.

Pelvic floor exercises

Pelvic floor exercises improve blood flow to the perineum and genital tissues to assist in healing, and also work to strengthen and tighten muscles that were stretched during birth. Ask a midwife or physiotherapist to explain how to do these if you are unsure.

Perineal ice packs

Ice packs can provide great relief if you are experiencing pain or burning in your perineum and genitals. They can also reduce swelling and inflammation.

 

Medical

Painkillers

Over-the-counter painkillers like paracetamol may be enough to help you manage any pain after birth. You might also use paracetamol with codeine. Non-steroidal anti-inflammatory drugs are often used as well. These are commonly given as suppositories to be delivered rectally.

Perineal ultrasound treatment

A physiotherapist may recommend ultrasound treatments to aid in the healing of the perineum.

Topping up medication after birth

If you had an epidural catheter inserted, doctors may choose to keep this in place after the birth is over in order to keep pain relief medication topped up until your pain is less severe. Not all doctors recommend this, so discuss your options with your medical team.

 

Possible complications of an epidural or spinal block

Modern medical pain relief options are very reliable and safe, but all medical procedures carry some risk. In rare cases, complications can occur. Doctors do not routinely advise patients of every possible side effect or complication, especially when patients are in a lot of pain and eager to make the pain stop as soon as possible. If you are concerned about possible side effects from epidurals or other pain relief methods, discuss these with your doctor.

Some of the possible epidural side effects and complications are:

  • An epidural may not provide adequate pain relief as expected.
  • Sometimes anaesthetic does not spread evenly around the spinal nerves, so pain relief can be irregular or ineffective. You may continue to feel pain one one side of your body. This is usually solved by topping up the medication or repeating the treatment.
  • Walking around is often impossible following an epidural or spinal block. You may experience heaviness or numbness in the legs that prevents movement. This depends on your dose of anaesthetic and the type given. Discuss with your anaesthetist if you are concerned about this.
  • While an epidural is in effect, it can be difficult to tell if your bladder is full. A urinary catheter may be inserted to empty your bladder.
  • Tenderness and bruising may occur around the area where the needle was inserted.
  • Shivering, nausea and vomiting may occur during an epidural, however these symptoms often occur during normal labour as well.
  • Intense itching can occur with some types of epidural, which is then treated with medication.
  • A fall in blood pressure can occur after a spinal block is given. Normally an intravenous drip line is inserted before the spinal block so that medication and fluids can be delivered quickly if needed. This prevents any harm to the baby caused by a potential fall in blood pressure.
  • Spinal fluid can occasionally leak, causing a headache. This occurs in about 1% of patients, and is usually treated by several days of rest while the leak seals itself. Sometimes a leak of spinal fluid requires further treatment.
  • A third of women experience a backache in the weeks after an epidural or spinal block, however a third of women who have not had an epidural also experience a backache in the weeks after giving birth.
  • Rarely, an allergic reaction to an anaesthetic may occur.

Some of the more rare and serious complications and side effects of epidural or spinal anaesthesia are:

  • The site of puncture and the surrounding area can become infected. This requires antibiotic treatment and sometimes surgery.
  • The anaesthetic can mistakenly be injected into a blood vessel. This can cause dizziness and a metallic taste in the mouth. In serious cases, this can result in convulsions and depression of the heart.
  • Temporary damage to spinal nerves outside the spinal column can occur. This occurs in roughly one in 3,000 women, and recovery normally takes place within a few weeks. Temporary nerve damage can also be caused by labour itself.
  • Rarely, a block can affect breathing.
  • Some patients experience permanent spinal nerve damage, but this is rare. This is seen in about one patient per 10,000.
  • Permanent paralysis or death are possible but so rare that the exact risk is unknown.

Talk to your doctor

This article provides general information that is not a substitute for personalised advice from your doctor. It does not include all information about pain relief during childbirth. You should always consult your doctor when making decisions about your care. If you wish to avoid medical intervention during childbirth, be sure to advise your doctor of this in advance.

If you are unsure about anything mentioned in this article or you would like more information, please ask your doctor. If you are unsure about the advice given by your doctor, seek the opinion of a second doctor.